Provider Demographics
NPI:1215196126
Name:MOKHTAR, ERIN (MFT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MOKHTAR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:4964 OLIVE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5658
Mailing Address - Country:US
Mailing Address - Phone:818-912-3634
Mailing Address - Fax:
Practice Address - Street 1:21825 ERWIN ST # 1122
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3610
Practice Address - Country:US
Practice Address - Phone:818-912-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist